Sleep inequities at the intersections of racialized, gender, and sexual identity in the U.S.: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).
Zubizarreta D, Beccia A, et al. • Sleep health • 2026
Multiply marginalized groups (e.g., people of color who are also LGBQ+) had the highest prevalence of both short and long sleep duration, suggesting equity-focused policies and interventions targeting sleep health should center the needs and priorities of these groups.
Key Findings
Results
Multiply marginalized groups defined by the intersection of racialized minority identity and LGBQ+ identity had the highest prevalence of both short and long sleep duration.
Data came from the 2022 Behavioral Risk Factor Surveillance System with a sample of N = 235,326
Participants were grouped into 20 intersectional social strata jointly defined by racialized identity and sex/sexual identity
Racialized identity categories included Black, Latine, White, and multiracial/other
Sex/sexual identity categories included heterosexual-cisgender males, heterosexual-cisgender females, LGBQ-cisgender males, LGBQ-cisgender females, and trans and gender nonconforming people
Methods
The study used an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) framework to estimate sleep outcome prevalence across population subgroups.
Bayesian multilevel logistic models were fit to obtain intersectional social stratum-specific prevalence estimates for each outcome
Two adverse sleep outcomes were examined: short sleep duration and long sleep duration
The MAIHDA approach allowed for simultaneous estimation of prevalence across 20 intersectional strata
The intersectional framework allowed quantification of inequities across jointly defined social identity dimensions rather than single axes
Results
Sleep inequities were found to be patterned across intersecting dimensions of racialized identity, sex, and sexual identity in the U.S.
Prior research had limited examination of sleep outcome patterning across intersecting social identity dimensions
The study examined both short and long sleep duration as adverse outcomes
The 2022 BRFSS data provided a large nationally representative sample (N = 235,326) to support intersectional analysis
The study identified that considering single axes of identity alone would be insufficient to capture the full pattern of sleep inequities
Conclusions
Equity-focused policies and interventions targeting sleep health should center the needs and priorities of multiply marginalized groups who are at particularly elevated risk of both short and long sleep duration.
Both short and long sleep duration were identified as adverse outcomes, indicating multiply marginalized groups face risk across multiple dimensions of sleep health
The findings point to the importance of intersectionality as an analytic and policy framework for addressing sleep health disparities
Trans and gender nonconforming people were included as a distinct category, recognizing their unique social positioning
The study authors note that sleep inequities are 'marked and persistent' in the U.S., underscoring the urgency of targeted interventions
What This Means
This research examined how sleep problems are distributed across different groups of people in the United States, looking simultaneously at race, gender, and sexual identity rather than considering each characteristic separately. Using data from over 235,000 Americans surveyed in 2022, the researchers grouped people into 20 categories that combined their racialized identity (Black, Latine, White, or multiracial/other) with their gender and sexual identity (such as heterosexual cisgender men, LGBQ cisgender women, or transgender and gender nonconforming people). They then estimated how common both too-little sleep and too-much sleep were in each of these groups.
The study found that people who belong to multiple marginalized groups—for example, people of color who are also LGBQ+—were most likely to experience unhealthy sleep patterns, both sleeping too little and sleeping too much. This suggests that the compounding effects of holding multiple marginalized identities are associated with greater sleep health risks than any single identity dimension would predict on its own.
This research suggests that public health efforts to improve sleep health in the U.S. need to go beyond addressing race or sexual identity or gender identity in isolation. Programs and policies aimed at reducing sleep disparities may be most effective when they specifically account for the experiences and needs of people who face discrimination and disadvantage along multiple dimensions of their identity simultaneously. The findings highlight that a one-size-fits-all approach to sleep health equity may miss those who are most at risk.
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Zubizarreta D, Beccia A, Chen J, Coull B, Bryn Austin S. (2026). Sleep inequities at the intersections of racialized, gender, and sexual identity in the U.S.: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).. Sleep health. https://doi.org/10.1016/j.sleh.2026.07.014